[Cancer screening service utilization and willingness-to-pay of urban populations in China: a cross-sectional survey from potential service demander's perspective]

Objective: To explore the sustainability of cancer screening strategy from potential demander's perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China (CanSPUC) or any other national level cancer screening projects. Methods: Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results: A total of 16 394 participants were included in this study. Among them, 12.1% (1 984/16 394) had ever been on a cancer screening program. Populations with following characteristics as: being elderly (60-69 years, OR=1.27, 95% CI: 1.13-1.43), female (male, OR= 0.56, 95%CI: 0.50-0.62), having had higher education (high school/specialized secondary school, OR= 1.51, 95%CI: 1.35-1.70; college or over, OR=2.10, 95%CI: 1.36-3.25), working for public (OR=2.85, 95% CI: 2.26-3.59), enterprises or self-employed agencies (OR=1.32, 95% CI: 1.06-1.64), having higher income (60 000-150 000 Chinese Yuan, OR=1.55, 95%CI: 1.39-1.73; ≥150 000 Chinese Yuan, OR=2.57, 95% CI: 2.09-3.15), under basic medical insurance programs for urban employees/for government servants'(OR=1.15, 95% CI: 1.01-1.32), on basic medical insurance set for urban residents'/on commercial medical insurance programs etc. (OR=1.01, 95%CI: 0.84-1.22), were in favor of the services. When neglecting the fee for charge, 65.8% (10 795/16 394) of the participants said that they could accept the cancer screening program, particularly in those who had already been on the screening program (P<0.05). 61.2% (10 038/16 392) of all the participants showed the willingness-topay for a long-term packaging screening services, particularly in those who were relatively younger (60-69 years, OR=0.80, 95%CI: 0.74-0.87), working for public (OR=1.76, 95%CI: 1.56-1.98) or enterprise sectors or self-employed households (OR=1.32, 95%CI: 1.18-1.47), having higher income (60 000-150 000 Chinese Yuan, OR=1.51, 95%CI: 1.40-1.63; ≥150 000 Chinese Yuan,OR= 1.95, 95% CI: 1.60-2.38), utilized screening services (OR=2.18, 95% CI: 1.94-2.46). Conclusions: The rate of using the cancer screening services should be improved. Factors including age, gender, education, occupation, income and insurance appeared as major factors related to the use of cancer screening services. Willingness-to-pay seemed relatively high, but the amount of payment they could afford was limited. Factors including age, occupation, income and insurance appeared as major factors to the willingness-to-pay.